Catalyzing HIV and TB ResearchCatalyzing HIV and TB Research
Diane V. Havlir, MD
University of California,
San Francisco, CADiane V. Havlir, MD
University of California, San Francisco
Chair, WHO HIV/TB Working Group, Stop TB
HIV/TB: Current Landscape HIV/TB: Current Landscape
� 1.37 million new cases of TB in HIV+ population in 2007
� TB one of greatest threats to success of ART
� TB burden in HIV population is a major obstacle in realizing global TB reductions
� Universal HIV testing in TB clinics
� Expansion of TB case finding in HIV clinics
� TB prevention through IPT and infection control
� Prevention and treatment of MDR/XDR
� Increased models of integrated HIV/TB care
� Investment in TB/HIV research – children included
WHO HIV/TB Working Group Goals and Vision
TB POSES A RISK IN HIV THROUGHOUT THE COURSE OF DISEASE
RISK OF TB
Prevention Strategies for TB among persons with HIV
Prevention Strategies for TB among persons with HIV
� INH and beyond
� Antiretroviral therapy
� Identification and treatment of active cases
� TB vaccines
Infection Control in TB Infection Control in TB
� TB is being transmitted in the health care setting between patients
� Approximately half of cases of recent XDR outbreak of TB in South Africa were acquired in health care setting
� HCW are 5 fold more likely to acquire TB compared to general population
� Innovative and strategic approaches are needed
TB Diagnosis: MomentumTB Diagnosis: Momentum
Point of
care
dipstick
A5221/STRIDE CAMELIA SAPIT
ENDPT
SITES
N
ARMS
634/800
Africa, Asia, SA, NA
429/429660/660
Cambodia South Africa
Imm vs 8-24Imm vs 8Imm vs 8-12
Death, AIDS Death Death
When to Start ART during TB treatment
When to Start ART during TB treatment
194
4
195
2
195
6
196
5
196
8
Strep INH
PZA
Rifampin
EMB
199
8
RPT
TB Drug Development 1944-2009TB Drug Development 1944-2009
ZDVddI
ddCd4T
SQV
3TC
RTV
IDV
NVP
NFV
DLV
EFV
ABC
APV
LPV/
RTVTDF
TPV
DRV
ATV
FPV
ENF
FTC
Years
0
5
10
15
20
25
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
RTG
MVC
Adapted from clincaloptions.com/hiv (Oct, 2007)
NRTI
NNRTI
PI
FUSION INHIBITOR
CCR5 BLOCKER
INTEGRASE INHIBITOR
Antiretrovirals 1987-2009Antiretrovirals 1987-2009
TMC207 shortens time to culture conversion in MDR population
TMC207 shortens time to culture conversion in MDR population
p=0.003
(a) p-value from Cox proportional model adjusting for strata
9%
48%
Diacon, NEJM, 2009
N=47
6 HIV+
Countries with confirmed cases of XDR-TB as of November 2008
Meeting Outcomes Meeting Outcomes
� New ideas, collaborations and networking
� HIV/TB Research Priorities Publication
� TB satellite symposium Tuesday at IAS meeting